A Case Report of Herpes Zoster After Botulinum Toxin Injections.

This case report presents a rare occurrence of herpes zoster (HZ) outbreak in a 50-year-old male following botulinum toxin (BTX) type A injections. The patient developed burning swollen lesions on the left forehead four days after receiving BTX injections. Physical examination revealed papules and erosions in a dermatomal distribution. He was diagnosed with HZ and promptly treated with oral acyclovir. The lesions resolved within two weeks without complications. Previous literature reports a few similar HZ outbreaks following aesthetic treatments with BTX injections. The exact mechanism triggering varicella reactivation in these cases remains unclear. Prompt diagnosis and treatment of HZ are crucial in order to minimize outbreak duration and reduce complications. Physicians should maintain awareness of HZ as a potential complication following BTX injections.

Efficacy of Adipocyte-Derived Stem Cells-Conditioned Media in Telogen Effluvium.

Objectives: To assess the effectiveness of adipocyte-derived mesenchymal stem cells-conditioned media (ADSC-CM) formulation in telogen effluvium patients. Methods: A retrospective cohort study was conducted at a dermatology clinic in Jeddah, Saudi Arabia. The study included 50 consecutive patients aged 20-70 years, who were diagnosed with telogen effluvium. All patients received five monthly sessions of the same commercial ADSC-CM formulation, using a standardized application protocol. Pre- and post-intervention changes in trichometry parameters were analyzed. Results: There was a significant increase in mean hair density (up to 29.01 hair/cm2; effect size 0.7-1.0), cumulative hair thickness (up to 2.67 units; effect size 0.7-1.4), and the number of follicular hair units (up to 19.96%; effect size 1.0-1.3) in all scalp regions (p < 0.001), associated with a decrease in mean trichometry-derived Sinclair scale by 0.8-1.3 (p < 0.001). Positive outcomes were observed in 70%-92% of the patients depending on the parameter and scalp region. There was no impact of the patient's age on ADSC-CM efficacy. Conclusion: ADSC-CM was successfully applied as a new treatment option for patients with telogen effluvium. These findings provide another therapeutic and research area for dermatologists to optimize the management of telogen effluvium and reduce its impact on patients.

Assessment of Occipital Involvement Among a Large Population of Females with Pattern Hair Loss in Saudi Arabia.

Background: Cumulative evidence suggests the involvement of the occipital region in female pattern hair loss (FPHL). However, most of the studies that have been published so far concerned relatively small samples of patients. Purpose: To assess the occipital involvement in FPHL and analyze its correlation with disease severity among a large sample of patients. Patients and Methods: A retrospective study involved 1000 adult women with FPHL, between January 2020 and August 2022. Occipital involvement was defined as more than 10% of thin hairs (<0.03 mm). Baseline trichometry parameters in the frontal and occipital regions were analyzed. Results: Occipital involvement was observed in 32.4% of the patients. Positive correlations between frontal and occipital regions were observed for all trichometry parameters; the strongest concerned average hair shaft thickness (Pearson's coefficient r=0.708), cumulative hair thickness (r=0.673), and trichometry-derived Sinclair scale (r=0.656). The risk of occipital involvement increased independently with the disease severity in frontal region; however, the disease progression was slower in the occipital compared to frontal region. Conclusion: One-third of females in our study with FPHL had occipital involvement. This has a major impact on the methods used to diagnose pattern hair loss in females and their treatment plan including hair restoration surgery.

Short-Term Efficacy of Autologous Cellular Micrografts in Male and Female Androgenetic Alopecia: A Retrospective Cohort Study.

PURPOSE: Autologous cellular micrografts (ACM) is a novel treatment method in hair loss, and few data are available regarding its efficacy. The present study was carried out to assess the short-term clinical efficacy of a single application of ACM in the treatment of male and female androgenetic alopecia (AGA). MATERIALS AND METHODS: This was a single-center retrospective study involving 140 consecutive adults with confirmed AGA, who received a single session of ACM (Regenera Activa®). Efficacy was evaluated 1-6 months after treatment, by analyzing the change of trichometry parameters, which were assessed using TrichoScan digital image analysis. RESULTS: Depending on the scalp region, there was increase in mean hair density by 4.5-7.12 hair/cm2, average hair thickness by 0.96-1.88 µm, % thick hair by 1.74-3.26%, and mean number of follicular units by 1.30-2.77, resulting in an increase of cumulative hair thickness by 0.48-0.56 unit. Additionally, the frontal region showed a significant decrease in % thin hair (-1.81%, p = 0.037) and yellow dots (-1.93 N/cm2, p = 0.003). A favorable response was observed in 66.4% of the participants in the frontal region. Further, a gender-specific effect of treatment was observed. CONCLUSION: ACM is a promising treatment in AGA with a short-term favorable response observed in up to approximately two-thirds of patients.

Consensus Opinions on Facial Beauty and Implications for Aesthetic Treatment in Middle Eastern Women.

BACKGROUND: Middle Eastern women worldwide increasingly seek aesthetic treatment to enhance their beauty and improve self-esteem, but literature describing standards of beauty across the Middle East are scarce. Knowledge of facial anthropometry and Middle Eastern subregional beauty preferences and aesthetic weaknesses are key to develop an effective facial enhancement strategy that does not jeopardize ethnic identity or facial harmony. METHODS: Dermatologists and plastic surgeons from 8 Middle Eastern countries who had 7.5-25 (mean 13.5) years of experience in aesthetic medicine examined female Middle Eastern beauty in 4 geographic subregions: the Gulf (comprising Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates), Iran, Lebanon, and Egypt. They developed consensus opinions regarding facial beauty, aesthetic deficiencies, and injectable treatment solutions. RESULTS: Facial anthropometry differs between Middle Eastern and Western women, and also within the region. Although subregional differences are seen, beauty is generally recognized by an oval or round face; temple fullness; pronounced, elevated, arched eyebrows; large almond-shaped eyes; well-defined, laterally full cheeks; a small, straight nose; full lips; a well-defined jawline; and a prominent, pointed chin. The relative prominence of the nose necessitates attention to the lips and the shape and projection of the chin. Aging is often accompanied by midface sagging that leads to increased heaviness in the lower facial third. CONCLUSIONS: Middle Eastern beauty is characterized by striking eyes, defined cheeks, and full lips. These consensus opinions inform aesthetic practitioners who treat Middle Eastern women worldwide about their aesthetic ideals and the implications for treatment.

The association between stress and acne among female medical students in Jeddah, Saudi Arabia.

INTRODUCTION: Although there is widespread acceptance of a relationship between stress and acne, not many studies have been performed to assess this relationship. The objective of this study was to determine the relationship between stress and acne severity. METHODS: A cross-sectional study was conducted among 144 6th year female medical students 22 to 24 years in age attending the medical faculty at King Abdulaziz University. This study used the global acne grading system (GAGS) to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). The questionnaire also included some confounding factors involved in acne severity. RESULTS: The results indicated an increase in stress severity strongly correlated with an increase in acne severity, which was statistically significant (p<0.01). Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS. CONCLUSION: On the basis of this study, it is concluded that stress positively correlates with acne severity.

Universal Trichloroacetic Acid Peel Technique for Light and Dark Skin.

IMPORTANCE: Despite their great potential, medium and deep trichloroacetic acid peels are underused in light-skinned patients and are rarely used in darker-skinned patients because of the widespread fear of pigmentary complications and scarring. This concern has led many physicians to opt for the use of lighter types of peels (glycolic acid peel, Jessner peel, etc) and different lasers and intense light technologies. Trichloroacetic acid peels have been described in numerous publications. However, no study to date has described the precise technique and the practical pearls of a successful trichloroacetic acid peel approach in a clear, detailed, and reproducible manner. OBJECTIVES: To clarify a practical approach to a universal trichloroacetic acid peel and to offer novice and experienced facial plastic surgeons an organized, easy, and safe technique for medium and deep trichloroacetic acid peels. DESIGN, SETTING, AND PARTICIPANTS: This study was a case series of universal trichloroacetic acid peels in an academic setting. The study dates were January 1, 1996, to November 1, 2015. MAIN OUTCOMES AND METHODS: This article discusses the preoperative evaluation for a chemical peel, a previously published genetico-racial skin classification, and the trichloroacetic acid peel technique, which aims at standardizing and controlling the application of the acid to improve results and lessen complications. The "strip" technique is described, which increases the physician's control over the peel depth. RESULTS: A total of 923 trichloroacetic acid peels in 803 female patients (87.0%) and 120 male patients (13.0%) were reviewed (mean age, 41.59 years). The follow-up period ranged from 6 months to 13 years (mean, 13 months). This case series revealed a low incidence of complications, including 54 patients (5.9%) with persistent hyperpigmentation, 3 patients (0.3%) with mild telangiectasia, 2 patients (0.2%) with acute herpesvirus infection, 2 patients (0.2%) with bacterial Staphylococcus infection, and 1 patient (0.1%) with hypopigmentation. CONCLUSIONS AND RELEVANCE: When properly applied, trichloroacetic acid peels are efficient and safe for light and dark skin. The technique can be an easily implementable addition to a physician's cosmetic practice. LEVEL OF EVIDENCE: 4.

Local Anesthesia Techniques in Hair Restoration Surgery.

Pain during hair restoration surgery and other dermatologic surgery procedures is one of patients' main fears. The authors briefly describe local anesthesia techniques they use in their surgical practice that make these procedures more pleasant for patients. The ability to provide a pain-free experience during hair restoration surgery will increase patients' satisfaction and allow patients to return for subsequent procedures.

Epidemiologic and genetic characteristics of alopecia areata (part 2).

Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease mediated by T cells to the hair follicles. Despite the fact that most cases of AA are sporadic, there is an accumulation of evidence that AA is a complex multigenetic trait with components of inherited predisposition. In the last decade, rapid progress in molecular genetics and biotechnology has led to the identification of many candidate genes in humans that confer susceptibility to AA. The first part of this review focused on the association of HLA genes with the disease. The second part reviews non-HLA and other genes associated with AA, including the autoimmune regulator (AIRE) gene. Recently, the lymphoid-specific protein tyrosine phosphatase, non-receptor type 22 (PTPN22) gene was found to be an additional immunoregulatory gene associated with AA. In addition, alleles of genes coding for cytokines and their receptors, such as the interleukin-1 receptor antagonist (IL1RN) and chemokines (MCP-1), have also been associated with AA. Some studies have hypothesized that filaggrin gene mutations (FLG) may also play a role in AA, particularly in patients with comorbid atopic disease. MX1 is another new candidate gene in AA. Thus, this second part of the review completes the overview of current knowledge about the molecular genetics of AA begun in the first part.